Provider Demographics
NPI:1821672775
Name:PACKER, RENEE (LSW)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:PACKER
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 490
Mailing Address - Street 2:
Mailing Address - City:YORKVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60560-0490
Mailing Address - Country:US
Mailing Address - Phone:630-777-6385
Mailing Address - Fax:
Practice Address - Street 1:3033 OGDEN AVE STE 210
Practice Address - Street 2:
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-1976
Practice Address - Country:US
Practice Address - Phone:877-443-7030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-07
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL24714721041S0200X
IL150105074104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool